Evaluation of a Theory-Informed Implementation Intervention for the Management of Acute Low Back Pain in General Medical Practice: The IMPLEMENT Cluster Randomised Trial

This cluster randomised trial evaluated an intervention to decrease x-ray referrals and increase giving advice to stay active for people with acute low back pain (LBP) in general practice. General practices were randomised to either access to a guideline for acute LBP (control) or facilitated intera...

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Vydáno v:PloS one Ročník 8; číslo 6; s. e65471
Hlavní autoři: French, Simon D., McKenzie, Joanne E., O'Connor, Denise A., Grimshaw, Jeremy M., Mortimer, Duncan, Francis, Jill J., Michie, Susan, Spike, Neil, Schattner, Peter, Kent, Peter, Buchbinder, Rachelle, Page, Matthew J., Green, Sally E.
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States Public Library of Science 13.06.2013
Public Library of Science (PLoS)
Témata:
Access control
Adult
Australia
Back pain
CAT scans
Clinical trials
Clusters
Computed tomography
Evidence-based medicine
Family medicine
Family Practice
Female
Group dynamics
Health care
Health Knowledge, Attitudes, Practice
Humans
Interactive control
Intervention
Low back pain
Low Back Pain - diagnostic imaging
Low Back Pain - rehabilitation
Male
Medical practice
Medical research
Medicine
Middle Aged
Motivation
Pain
Pain management
Patient Compliance
Preventive Health Services
Preventive medicine
Radiography
Randomization
Referral and Consultation
Simulation
Statistical analysis
Systematic review
Workshops
X-rays
Australia
Victoria Australia
ISSN:1932-6203, 1932-6203
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Shrnutí:This cluster randomised trial evaluated an intervention to decrease x-ray referrals and increase giving advice to stay active for people with acute low back pain (LBP) in general practice. General practices were randomised to either access to a guideline for acute LBP (control) or facilitated interactive workshops (intervention). We measured behavioural predictors (e.g. knowledge, attitudes and intentions) and fear avoidance beliefs. We were unable to recruit sufficient patients to measure our original primary outcomes so we introduced other outcomes measured at the general practitioner (GP) level: behavioural simulation (clinical decision about vignettes) and rates of x-ray and CT-scan (medical administrative data). All those not involved in the delivery of the intervention were blinded to allocation. 47 practices (53 GPs) were randomised to the control and 45 practices (59 GPs) to the intervention. The number of GPs available for analysis at 12 months varied by outcome due to missing confounder information; a minimum of 38 GPs were available from the intervention group, and a minimum of 40 GPs from the control group. For the behavioural constructs, although effect estimates were small, the intervention group GPs had greater intention of practising consistent with the guideline for the clinical behaviour of x-ray referral. For behavioural simulation, intervention group GPs were more likely to adhere to guideline recommendations about x-ray (OR 1.76, 95%CI 1.01, 3.05) and more likely to give advice to stay active (OR 4.49, 95%CI 1.90 to 10.60). Imaging referral was not statistically significantly different between groups and the potential importance of effects was unclear; rate ratio 0.87 (95%CI 0.68, 1.10) for x-ray or CT-scan. The intervention led to small changes in GP intention to practice in a manner that is consistent with an evidence-based guideline, but it did not result in statistically significant changes in actual behaviour. Australian New Zealand Clinical Trials Registry ACTRN012606000098538.
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Conceived and designed the experiments: SDF JEM DAO JMG DM SEG. SEG was the lead investigator of the funding application. Analyzed the data: JEM. Wrote the first draft of the paper: SDF JEM. Contributed to revisions of the manuscript and approved the final version: SDF JEM DAO JMG DM JJF SM NS PS PK RB MJP SEG. Designed and/or delivered the intervention: SDF JEM DAO JMG JJF SM NS PS RB SEG. Acquired the data: SDF MJP.
Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0065471